Senile anorexia in acute-ward and rehabilitations settings.

UNLABELLED: The most common pathological change in eating behaviour among older persons is anorexia, which accounts for a large percent of undernutrition in older adults. The main research aims are to determine, in a sample of acute and rehabilitation elderly subjects, the prevalence of anorexia of aging and the causes most impacting on senile anorexia. METHODS: four different Units cooperated to this research study. Patients were recruited from geriatric acute and rehabilitation wards in Italy. Each Research Unit, for the estimation of the prevalence of anorexia in elderly subjects evaluated all the patients aged over 65 recruited from April 2006 to June 2007. Nutritional status, depression, social, functional and cognitive status, quality of life, health status, chewing, swallowing, sensorial functions were evaluated in anorexic patients and in a sample of "normal eating" elderly subjects. RESULTS: 96 anorexic subjects were selected in acute and rehabilitation wards (66 women; 81.5 +/- 7 years; 30 men: 81.8 +/- 8 years. The prevalence of anorexia in the sample was 33.3% in women and 26.7% in men. Anorexic subjects were older and more frequently needed help for shopping and cooking. A higher (although not statistically significant) level of comorbidity was present in anorexic subjects. These subjects reported constipation and epigastrium pain more frequently. Nutritional status parameters (MNA, anthropometry, blood parameters) were significantly worst in anorexic subjects whereas CRP was higher. Chewing and swallowing efficiencies were significantly impaired and eating patterns were different for anorexic subjects with a significant reduction of protein rich foods. CONCLUSIONS: consequences of anorexia can be extremely serious and deeply affect both patient's mobility, mortality and quality of life. Therefore, it is of utmost importance to perform a special evaluation of the nutritional risk, to constantly evaluate the nutritional status and feeding intake of older patients, to identify and treat the underlying disease when possible, to institute environmental and behavioural modifications, to organise staff better in order to produce higher quality feeding assistance during mealtimes, to plan early nutrition rehabilitation and nutritional education programs for caregivers. There is also the necessity to develop diagnostic procedures easy to perform, able to identify the pathogenesis of anorexia and, therefore, treatment strategies exactly fitting the patients' needs.

[Laparoscopic hysterectomy after GnRh analogue therapy]. / Isterectomia laparoscopica dopo trattamento con analoghi del GnRh.

AIM: The aim of this clinical prospective study was to evaluate the effectiveness of the GnRh analogues treatment carried out before the implementation of a laparoscopic hysterectomy on patients affected by fibromatosis and metrorrhagia. METHODS: We examined a cohort of 40 women sharing an average uterine volume of 510+/-95 cm3 observed in a time span of 22 months. Precociously, in the follicular phase we treated our sample of patients with only one ampoule of triptorelin 11.25 mg in a short-term regime. At the end of the treatment, after about 3 months, we re-scanned by ultrasound the uterine volume before carrying out the surgical treatment. RESULTS: The presurgical treatment with GnRh analogues allowed a significant reduction of the uterine volume of about 4% in 34 cases (85% patients) as confirmed by ultrasound. The Student t test revealed significant difference before and after the treatment with a P value <0.05. Further, we obtained an increase of about 2-3 g of hemoglobin. The average treatment time was of about 130 min (ranging from 110 to 160 min). The only intrasurgical complication consisted in a vescical lesion which we repaired without consequences. In the postsurgical period we incurred in only 3 cases of fever (38.5 degrees C) which required an antibiotic therapy. The average length of hospitalization was three days. CONCLUSION: The presurgical treatment with GnRh analogues can be considered a valuable option in the management of the uterine leiomyomas pathology.

[Occupational contact dermatitis in metal workers and gender effect]. / Dermatiti professionali nei metalmeccanici ed effetto di genere.

Contact dermatitis is more frequent among women for anatomical reasons and for extraprofessional exposure to irritants and detergents during homeworks. In addition sensitisation to contact haptens is different in sexes. The aim of our work was to evaluate the association between patch test skin sensitizations and professional exposure to metals analyzing data for gender. Of the 15.217 patients patch tested for dermatitis, 678 were metalworkers. The statistical analysis revealed a significant association between dermatitis and sensitisation to nickel in professional exposed women (OR = 1.68; LC50% 1.11-6.50) while metal sensitisation (Cr.Ni and Co) was not relevant in men: for them a significant association between dermatitis and sensitisation was found to quaternium (OR = 3.91; LC95% 1.18-12.9), to mercaptobenzothiazole (OR = 2.69; LC50% 1.11-6.50) and to ethylendiamine dichloride (OR = 2.53; LC95% 1-6.41). The authors stress the need to evaluate patch test sensitisation considering gender effects.

Effects of treatment with embryonic and uterine tissue homogenates on Lewis lung carcinoma development.

Based on the hypothesis that the development of cancer is actively inhibited during embryonic life, the effects on tumor growth of homogenates of different tissues (embryos, uteri at ninth day of pregnancy, non-pregnant uteri and normal liver) were investigated in syngeneic C57BL/6 female mice. Primary tumor growth and spontaneous pulmonary metastasis formation were completely suppressed in the group of mice treated with pregnant uteri homogenates. Embryos, non-pregnant uteri and normal liver homogenates were ineffective.

Platelet function and clotting parameters of vibration-exposed foundry workers.

Platelet aggregation and blood clotting parameters were studied in 22 workers (84 %) using pneumatic riveting and grinding hand tools and in 20 workers (90 %) not exposed to vibration but comparable with respect to age, anthropometric data, smoking and drinking habits, and atherogenic risk factors. The weighted acceleration levels of the vibrating tools are reported. According to Taylor's grading system for vibration-induced white fingers, 15 exposed workers (57 %) were in stage OT, 9 (34 %) in stage 0N, and 1 (4 %) in stage 1. Between the reference and the vibration-exposed groups no differences in the platelet aggregation indices both "in vitro" (adenosine-diphosphate, epinephrine, threshold adenosine-diphosphate concentration) and "in vivo" (platelet factor four, beta-thromboglobulin) were found. In addition the clotting parameters (prothrombin index, activated partial thromboplastin time, fibrinogen, antithrombin III) and the immunoglobulins G, A, and M were normal in the two groups. The measurement of skin temperature of the third right finger before and after the cold provocation test showed that the vibration exposed workers experienced a stronger vasoconstriction of the digital vessels than the referents. It is concluded that, in the early stages of vasospastic disorders, segmental vibration can induce peripheral vascular hyperreactivity without changes in the platelet function and clotting parameters.

Monounsaturated diet lowers LDL oxidisability in type IIb and type IV dyslipidemia without affecting coenzyme Q10 and vitamin E contents.

The purpose of the present study was to evaluate the effects of MUFA vs PUFA enriched diets on the plasma and LDL lipid profile and antioxidant contents in mild hypercholesterolemic and triglyceridemic subjects. The study was divided in two consecutive diet periods. Two groups of 11 dyslipidemic patients each (type IIb and type IV) were recruited and during the first period (lasting four weeks) received a linoleic rich diet while during the following four weeks took an oleate rich diet. Both groups showed no significant changes in cholesterol and TG concentration either in plasma or in LDL. Coenzyme Q10 and vitamin E were also unaffected by the dietary treatments. LDL proneness to be oxidatively modified increased after dietary PUFA administration and markedly decreased following the virgin olive oil enriched diet. In fact, LDL from hypertrigliceridemic subjects on a oleate-enriched diet displayed a 26% (p < 0.05) longer lag-phase in conjugated dienes generation than during linoleate-enriched diet and at recruitment. In hypercholesterolemic subjects similar results were obtained: the lag-phase was 28% longer after MUFA diet that after PUFA diet. No differences were found in the maximum propagation rate and maximum concentration of conjugated dienes among dietary periods and at recruitment. Since we found that the vit. E and CoQ10 levels in plasma and in LDL particles remained unchanged during the course of the study, we may conclude that LDL proneness to undergo oxidative modifications is mainly the result of compositional change due to the enrichment from the different diets of the relative fats.

Analogue and digital instruments for non-invasive estimation of muscle fibre conduction velocity.

Analogue and digital instruments for non-invasive on-line measurement of muscle fibre conduction velocity (CV) have been designed, built and compared using test signals and real myo-electric signals. Their inputs consist of two single-differential or double-differential myo-electric signals, obtained using a three- or four-contact surface electrode system. The analogue device computes CV by tracking the lag of the zero-crossing of the cross-correlation between the first signal and the derivative of the second. The digital device computes the peak of the cross-correlation function between the two signals by sampling them at 50 KHz for 20 ms (or longer, up to 320 ms), computing CV in about 30 ms (or longer, up to about 670 ms) and resuming sampling. Both devices allow estimation of CV during either voluntary or electrically elicited contractions and include a stimulation stage and a signal conditioner with artefact suppression features. Both devices provide analogue and numerical outputs and allow interfacing with analogue and digital instrumentation. They can be used in clinical or in research environments for easy and quick identification of appropriate electrode locations and/or for monitoring CV during sustained voluntary or electrically elicited contractions. The digital version is more versatile and requires no adjustments; it provides an estimate based on intermittent reading of the signals and is more sensitive to noise and momentary CV fluctuations.

Influence of sport and low animal saturated fats intake diet on lipid dismetabolisms in postmenopausal women.

BACKGROUND: An important aetiopathogenetic factor leading to menopausal age pathologies (such as hypertension, diabetes, cardiovascular diseases and so on) is certainly represented by the worsening of lipid dismetabolism. This condition is generally characterized by an increase in total mean cholesterol levels, LDL-cholesterol (low density lipoprotein-cholesterol), VLDL-cholesterol (very low density lipoprotein-cholesterol), triglycerides, with reduction of HDL-cholesterol (high density lipoprotein-cholesterol) mean levels. All these metabolic modifications are triggered or increased by the hypoestrogenemia typical of postmenopausal age. The aim of our study was to evaluate the influence on postmenopausal women's lipid metabolism of a low contribution of animal saturated fat diets, associated with physical training. METHODS: We enrolled in our study 36 mild hypercholesterolemic postmenopausal women (non smokers and not complaining of hypertension and diabetes) and we put them through aerobic training, consisting of 1 hour of a light continuous run, repeated 4 times per week. The final control of their metabolic status and of their lipid order was executed after 6 months, but during this period, all the women were observed bi-weekly or monthly, to assure a high uniform compliance in the group. None of the women enrolled took specific drugs for the lipid metabolism during the study. RESULTS: After 6 months from the beginning of the diet, with associated physical training, an important weight loss was observed. Increases of HDL-cholesterol mean levels (p<0.05) associated with a decrease of total cholesterol mean levels (p<0.05) were reported in all the subject examined. A statistically non-significant decrease in LDL and VLDL cholesterol mean levels was also noticed. CONCLUSIONS: A mild lipid dysmetabolism in postmenopause may be corrected advantageously by an opportune diet associated with moderate, but constant, physical training.

[Esthesiometric thresholds in workers exposed to neuropathogenic chemical and physical agents]. / Soglie estesiometriche in esposti ad agenti chimici e fisici neuropatogeni.

Two-point discrimination (TPD) and depth sense perception (DSP) were measured by means of two aesthesiometers in the fingertips of 65 forestry workers exposed to chain saw vibrations and 46 shoe industry workers exposed to neurotoxic solvents (n-hexane). Two control groups, consisting of 31 and 46 healthy subjects, were also examined. The compound means of the TPD and DSP threshold values for the 2nd, 3rd and 4th digits of the right and left hands were significantly higher in the chain saw workers suffering from peripheral sensorineural disorders than in the asymptomatic chain saw workers and the controls (p less than 0.001). Among the forestry workers, a significant relationship was found between loss of tactile perception and vibration dose expressed in terms of four-hour energy-equivalent frequency-weighted acceleration (ISO 5349). The shoe workers, who were asymptomatic, had higher DSP threshold values than the controls (p less than 0.01). No differences in the mean values of TPD thresholds were observed between the exposed and control subjects. These results indicate that DSP is more sensitive than TPD in detecting "sub-clinical neuropathy". On the basis of our previous investigations, the specificity of aesthesiometric threshold testing was high, ranging from 93 to 100%. The sensitivity of the aesthesiometric method was lower than the specificity, varying from 52-56% for TPD to 67-72% for DSP. These findings suggest that aesthesiometry may be considered as a useful testing method to differentiate on a group basis between healthy subjects and workers exposed to physical and chemical agents affecting the peripheral nervous system.(ABSTRACT TRUNCATED AT 250 WORDS)

Allergic manifestations due to castor beans: an undue risk for the dock workers handling green coffee beans.

The main cause of allergic manifestations among workers handling green coffee beans (GCB) is sensitization to castor beans (CB), which are considered a common contaminant of the sacks used to transport coffee beans. The RAST inhibition test was used to evaluate the presence of GCB and CB allergens on the surface of the sacks coming from the major world producers of coffee and to ascertain the presence of the CB allergen in coffee beans. A significant concentration of the two allergens, i.e., GCB and CB, on the sacks was demonstrated, with the highest values found on sacks from Brazil, while the hypothesis of a significant CB contamination in coffee beans was not confirmed. We believe the presence of the CB allergen on the surface of the sacks is due to contamination occurring during stocking and transport and could easily be prevented. Appropriate measures taken during transport could effectively prevent this "undue" risk in dockers and probably also in coffee industry workers.

Storage mites and their role in the onset of asthma and oculorhinitis among cattle farmers in north-east Italy.

The results are reported of an epidemiological study carried out in the province of Treviso in north-east Italy. The research was designed to ascertain the sensitization, through an IgE mechanism, to the main allergens present on cattle farms. Also reported are the results of a mite survey undertaken in ten barns in the same region. Investigations revealed a significantly larger degree of sensitization to storage mites among cattle farmers than in the control subjects. This sensitization was well correlated with mite species to be found in cattle barns. However, the frequent co-sensitization to Dermatophagoides offers a topic for further study.

[Allergic sensitization and latex-associated symptoms in a group of health workers]. / Sensibilizzazione allergica e sintomi associati al lattice in un gruppo di lavoratori della sanità.

The presence of symptoms connected with the use of latex rubber gloves and sensitization to this allergen was studied in a group of 660 hospital workers who regularly used gloves as a means of protection. Symptoms connected with the use of gloves were reported by 153 subjects (23.2%) and were significantly associated with female subjects length of use and type of medical care. The majority of cases reported irritative symptoms (13.2%) whereas contact dermatitis and rash were reported by 3.6% and 5.5% of cases respectively. Systemic reactions (asthma and/or rhinitis) were reported by 5 subjects. Prick tests for latex were positive in 23 cases (3.5%), 15 of which were symptomatic. Positive skin reaction to latex was significantly associated with family atopy, personal case history and prick test. It is concluded that the presence of symptoms and sensitization to latex requires the implementation of preventive measures in order to reduce the risk of sensitization to a minimum, in addition to removal from exposure of those subjects who are already symptomatic or at risk.

[Prevalence of occupational allergy to laboratory animals in two towns of northern and central Italy]. / Prevalenza dell'allergia professionale agli animali di laboratorio in due città del nord e del centro Italia.

BACKGROUND: Laboratory animal allergy (LAA) is a well known occupational hazard for workers employed in biological and medical research institutes, but few Italian data on this disease exist. OBJECTIVES: The aim of our study was to evaluate the prevalence of LAA in 45 workers in Trieste (NE-Italy) and in 80 workers in Perugia (Central Italy) and to assess factors predisposing to sensitisation among subjects occupationally exposed to animals. METHODS: All subjects underwent a physical examination and responded to a standardized questionnaire for the evaluation of allergic respiratory symptoms and exposure data. Skin prick tests with common allergens and with hair extract from laboratory animals were performed and specific IgE was measured. Atopy was defined as positive skin prick test to common allergens. RESULTS: There were 60% atopic subjects in Trieste and 55% in Perugia and sensitisation to laboratory animal hair was found in 24.4% subjects in Trieste and in 35% in Perugia. The prevalence rates of LLA were respectively 11.1% and 11.2%; 2.3% and 3.7% complained of asthma while 8.9% and 7.5% complained of rhinitis. The resulting symptoms were significantly related to skin prick tests that were positive to laboratory animal hair (odds ratio (OR) = 7.64; 1.83-44.5), to skin prick test positivity to common inhalant allergens (OR = 5.29; 1.09-50.2), to common allergic symptoms (OR = 3.95; 1.05-18.2) and to exposure time exceeding 5 hours per day (OR = 5.45; 1.31-22.0). CONCLUSION: The role of atopy and of exposure time in causing LLA was confirmed and the need of prevention measures to reduce exposure in people at risk was discussed.

Senile anorexia in different geriatric settings in Italy.

OBJECTIVES: Anorexia is the most frequent modification of eating habits in old age, which may lead to malnutrition and consequent morbidity and mortality in older adults. We aimed to estimate the prevalence and factors associated to anorexia in a sample of Italian older persons living in different settings. Our secondary aim was to evaluate the impact of senile anorexia on nutritional status and on eating habits, as well as on functional status. DESIGN AND SETTING: Observational study in nursing homes, in rehabilitation and acute geriatric wards, and in the community in four Italian regions (Lazio, Sicily, Emilia-Romagna, and Veneto). PARTICIPANTS: 526 over 65 years old participants were recruited; 218 free-living subjects, 213 from nursing homes, and 96 patients from rehabilitation and acute geriatric wards in the context of a National Research Project (PRIN) from the Italian Ministry of Instruction, University and Research (2005-067913 "Cause e Prevalenza dell'Anoressia senile"). MEASUREMENTS: Anthropometric and nutritional evaluation, olfactory, chewing, and swallowing capacity, food preferences, cognitive function, functional status, depression, quality of life, social aspects, prescribed drugs, and evaluation of gastrointestinal symptoms and pain. Laboratory parameters included prealbumin, albumin, transferrin, C-reactive protein, mucoprotein, lymphocyte count, as well as neurotransmitters leptin, and ghrelin. Anorexia was considered as ≥50% reduction in food intake vs. a standard meal (using 3-day "Club Francophone de Gériatrie et Nutrition" form), in absence of oral disorders preventing mastication. RESULTS: The overall prevalence of anorexia was 21.2% with higher values among hospitalized patients (34.1% women and 27.2% men in long-term facilities; 33.3% women and 26.7% men in rehabilitation and geriatric wards; 3.3% women and 11.3% men living in the community) and in the oldest persons. Anorexic subjects were significantly less self-sufficient and presented more often a compromised nutritional and cognitive status. Diet composition analyses of anorexic older adults revealed a lower intake of all food groups and a general tendency to a monotonous diet. CONCLUSION: Anorexia is a frequent condition in older Italians, particularly those hospitalized, with important consequences in the nutritional and functional status. The analysis of dietary components and its quality along with the frequency of intake of single food groups may be useful to plan intervention strategies aiming to improve the nutritional and health status of older adults with anorexia. An early detection of anorexia followed by an adequate intervention in older hospitalized patients to avoid further worsening of clinical and functional status is warranted.

Musculoskeletal disorders in hospital nurses: a comparison between two hospitals.

Nursing staff members of a urban general hospital (GH) and a small oncological department (OD) were surveyed to determine the prevalence of occupational related musculoskeletal disorders (MSDs), the specific disabilities, accidents at work, and working time lost. All subjects had a medical examination to evaluate osteoarthicular disease and selected cases were invited to X-ray examinations. The purpose of this study was to compare MSDs in the two groups of nurses working in two hospitals with different work organization in the same geographical area, Pordenone in Italy. In the previous year 48% GH and 33% OD nurses reported back pain due to work, 29.4 and 16.1% respectively have had X-ray or orthopaedic examinations, 19.2% and 9.1% had been away from work because of back pain. All these differences are statistically significant. The analysis of musculoskeletal pain sites and working tasks in the two hospital workers shows no differences in distribution. Great difference exists when analysing the numbers of patients assisted by a nurse: 0.57 and 1.27 nurse/patients respectively in GH and OD. Our data indicate a high overall frequency of occupational back pain, similar to other studies in Europe. The comparison between the two hospitals suggests factors associated with the disorder: work tasks and particularly nurses/patients ratio are more important factors than age and length of exposure. Different work distribution, shift organization, a better ratio between nurses and patients, an improvement of equipment provision, and specific nurse-training with application of ergonomic methods could improve work efficiency radically and decrease injury rates.